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Pragmat Obs Res. 2016 May 20;7:11-20. eCollection 2016.

Variations in the management of fibromyalgia by physician specialty: rheumatology versus primary care.

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US Health Outcomes and Technology Assessment, Global Health Outcomes, Eli Lilly and Company, Indianapolis, IN, USA.
Lilly Research Labs, Global Health Outcomes, Eli Lilly and Company, Indianapolis, IN, USA.
Department of Medicine, Indiana University; VA Health Services Research and Development Center for Health Information and Communication, Regenstrief Institute, Indianapolis, IN, USA.
Rheumatology Associates, Division of Rheumatology Clinical Research, Swedish Medical Center; University of Washington School of Medicine, Seattle, WA, USA.
Chronic Pain and Fatigue Research Center, Michigan Institute for Clinical and Health Research, University of Michigan School of Medicine, Ann Arbor, MI, USA.
inVentiv Health Clinical, Indianapolis, IN, USA.
USMD Neuroscience, Lilly USA LLC, Eli Lilly and Company, Indianapolis, IN, USA.
Department of Family Medicine, University of California at San Diego School of Medicine, San Diego, CA, USA.



To evaluate the effect of physician specialty regarding diagnosis and treatment of fibromyalgia (FM) and assess the clinical status of patients initiating new treatment for FM using data from Real-World Examination of Fibromyalgia: Longitudinal Evaluation of Costs and Treatments.


Outpatients from 58 sites in the United States were enrolled. Data were collected via in-office surveys and telephone interviews. Pairwise comparisons by specialty were made using chi-square, Fisher's exact tests, and Student's t-tests.


Physician specialist cohorts included rheumatologists (n=54), primary care physicians (n=25), and a heterogeneous group of physicians practicing pain or physical medicine, psychiatry, neurology, obstetrics and gynecology, osteopathy, or an unspecified specialty (n=12). The rheumatologists expressed higher confidence diagnosing FM (4.5 on a five-point scale) than primary care physicians (4.1) (P=0.037). All cohorts strongly agreed that recognizing FM is their responsibility. They agreed that psychological aspects of FM are important, but disagreed that symptoms are psychosomatic. All physician cohorts agreed with a multidisciplinary approach including nonpharmacological and pharmacological treatments, although physicians were more confident prescribing medications than alternative therapies. Most patients reported moderate to severe pain, multiple comorbidities, and treatment with several medications and nonpharmacologic therapies.


Physician practice characteristics, physician attitudes, and FM patient profiles were broadly similar across specialties. The small but significant differences reported by physicians and patients across physician cohorts suggest that despite published guidelines, treatment of FM still contains important variance across specialties.


medical specialty; prospective observational study; treatment

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